Why does adult African-American smoking prevalence in California remain higher than for non-hispanic whites?

Objectives: To explain why, contrary to national trends, adult California African-American (AA) smoking prevalence remains higher than for non-Hispanic Whites (W) and to explore how future rates might change. Methods: Data from the random-digit-dialed California Tobacco Surveys from 1990 to 2002 (N approximate to 16,000-211,000) allowed for the examination of differences in current smoking prevalence, ever smoking (uptake), and successful smoking cessation over time by race/ethnicity and age group. Results: African-American (AA) adolescent (12-17 years) smoking prevalence was lower than Ws through 1996, but similar thereafter because of marked declines for Ws. After 1990, AA young adult (18-29 years) smoking prevalence was consistently 25% lower than Ws', and no evidence of delayed AA smoking initiation was seen. However, among older age groups (30-44 years and 45+ years), AA smoking prevalence was much higher, yielding higher overall adult (18+ years) prevalence. While ever smoking (uptake) was generally lower among AAs, successful cessation (5+ years) was much lower among AA adults, especially older age groups. Conclusions: Continued higher adult California AA smoking prevalence results from less successful quitting in older age groups. Increased successful cessation is critical for reducing near-term prevalence. Long-term forecasting is difficult because both AA and W adolescents now smoke at comparably low rates.